Los Angeles Medicaid Audit Lawyers

Raiser & Kenniff, PC, helps healthcare providers in every aspect of the medicaid audit, investigation and litigation process. We service physicians, physician groups, general healthcare professionals, pharmacies, nursing home, hospitals, and all other health facilities. It’s crucial that a healthcare provider It’s crucial when you are responding to a medicaid program audit notice, you hire an experienced Los Angeles medicaid audit lawyer who understands the complexities of what you’re about to face. The purpose of a medicaid audit is to find answers to issues the government agencies have. Correct responses to audit questions must be provided. It’s crucial there be answers from the beginning. If you give incorrect answers, they can be used against you later – including in litigation.

Depending on how the medicaid audit proceeds – criminal prosecution can also occur. For example, if a medicare auditor looks at a sample of patients and determines that billed treatment wasn’t medically necessary – they may look further. This could review further inquiries into your practices, a suspension of your medicare number – in addition to compelling you to reimburse for losses incurred.

At Raiser & Kenniff, our Los Angeles medicaid audit lawyers are dedicated to protecting the rights of physicians, and healthcare providers. We can handle all aspects of the audit – ranging from responding to the initial audit, to appeals and more. If you’ve received an audit letter, then you should immediately speak to an attorney. You may be exposed to severe financial and administrative penalties – including millions in penalties, years in prison, and forfeiture of your assets.

Medicaid Audit Explained

Many providers are focused on Medicare Recovery Audit Contractors. Attention should be also be paid to the Medicaid Integrity Program. MIP consists of audits similar to those of the RAC program. The MIP, is a program designed to increase detection, and prevention, of medicaid fraud. The Deficit Reduction Act of 2005 mandated the creation of the MIP program – including the hiring of MIC’s – medicaid integrity contractors, who are required to review, audit, and education. MIP’s aim was to recover inappropriate medicaid payment. MIP also supports the efforts of State medicaid agencies by providing oversight and technical support.

CMS’ responsibilites under MIP are:

1) Hire contractors who will review medicaid provider activities, who will audit claims, who will identify overpayments, and who will educate providers on medicaid program issues

2) Provide support and assistance to states to combat medicaid provider fraud

There are three types of MIC contracts you need to remember: review MIC’s, audit MIC’s, and education MIC’s. Audit MIC’s can review claims looking back over a 5 year period. RAC’s are limited to a 3 year look back period.

Once you are selected for an audit – you are referred to an audit MIC whose responsible for performing the audit. The Audit MIC will send a letter, request records from the provider. This is something we can help with. The Audit MIC will setup an entrance conference during the early phase of the audit. Audit MIC’s have great discretion to perform a field/desk audit – which is why having a Los Angeles medicaid audit attorney on hand can be helpful. MIC’s, unlike RAC’s, do not have medical record request limitation. Once the audit’s completed, the MIC prepares a draft audit report. It’s shared with the state Medicaid agency for review and research is done to ensure medicaid policies were followed. The draft is also shared with the provider, who is then given 30 days to comment and submit additional information.

Unlike RAC’s, Audit MIC’s aren’t paid a contingency fee – and are not responsible for collecting overpayments. Instead, the federal government collect the overpayments directly from the state – and the state collects it from the provider.

If you are facing a medicaid audit, we encourage you to contact our medicaid audit lawyers in Los Angeles. Get a risk free consultation and learn more on how we can help you.

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Disclaimer: The information provided on this website doesn't constitute legal advice, and isn't a warranty, or prediction, regarding the outcome of any legal issue. Every case is different, and the results will depend on the facts of the case.